U.S. patent number 5,601,601 [Application Number 08/282,892] was granted by the patent office on 1997-02-11 for hand held surgical device.
This patent grant is currently assigned to Unisurge Holdings, Inc.. Invention is credited to Robert D. Berkowitz, Jeffrey J. Christian, Michael Hogendijk, Jeffrey E. Holmes, Michael J. Orth, Elisha A. Tal.
United States Patent |
5,601,601 |
Tal , et al. |
February 11, 1997 |
Hand held surgical device
Abstract
Hand-held surgical assembly for use in performing a laparoscopic
medical procedure, comprising a housing. An actuator tube having a
bore therein is slidably mounted in the housing. A handle operated
mechanism is carried by the housing for causing reciprocatory
movement of the actuator tube assembly within the housing.
Inventors: |
Tal; Elisha A. (San Francisco,
CA), Hogendijk; Michael (Sunnyvale, CA), Orth; Michael
J. (San Jose, CA), Christian; Jeffrey J. (San Jose,
CA), Holmes; Jeffrey E. (San Jose, CA), Berkowitz; Robert
D. (Menlo Park, CA) |
Assignee: |
Unisurge Holdings, Inc.
(Duluth, GA)
|
Family
ID: |
25194560 |
Appl.
No.: |
08/282,892 |
Filed: |
July 29, 1994 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
|
806666 |
Dec 13, 1991 |
5433725 |
|
|
|
Current U.S.
Class: |
606/207;
606/174 |
Current CPC
Class: |
A61B
17/29 (20130101); A61B 17/2909 (20130101); A61M
39/06 (20130101); A61B 10/06 (20130101); A61B
18/1482 (20130101); A61B 2017/00353 (20130101); A61B
2017/2919 (20130101); A61B 2017/2929 (20130101); A61B
2017/2939 (20130101); A61B 2017/2946 (20130101); A61B
2017/3445 (20130101); A61B 2217/005 (20130101); A61B
2217/007 (20130101); A61B 2090/0817 (20160201) |
Current International
Class: |
A61B
17/28 (20060101); A61M 39/02 (20060101); A61M
39/06 (20060101); A61B 17/34 (20060101); A61B
18/14 (20060101); A61M 1/00 (20060101); A61B
10/00 (20060101); A61B 017/34 () |
Field of
Search: |
;606/51,52,174,205-211,139-142 ;128/751-755,4,6 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Buiz; Michael Powell
Assistant Examiner: Lewis; William
Attorney, Agent or Firm: Flehr, Hohbach, Test, Albritton
& Herbert
Parent Case Text
This application is a continuation-in-part of application Ser. No.
07/806,666, filed on Dec. 13, 1991, now U.S. Pat. No. 5,433,725.
Claims
What is claimed is:
1. A hand-held surgical device for use with a tool having proximal
and distal extremities, the tool having tool parts and an actuation
mechanism for operating the tool parts, the tool parts being
disposed at the distal extremity of the tool and the proximal
extremity being sized to be adapted to be grasped by the human hand
and for use in performing a laparoscopic medical procedure
comprising a handle assembly having proximal and distal extremities
and having a bore extending therethrough from the proximal
extremity to the distal extremity, said bore being sized so that
the tool can be removably positioned within the bore so that the
tool parts extend out of the bore at the distal extremity of the
handle assembly and so that the proximal extremity of the tool
remains out of the bore at the proximal extremity of the handle
assembly to permit the tool to be grasped by the human hand to
facilitate positioning of the tool within the bore, said handle
assembly including hand operated means adapted to cause operation
of the actuation mechanism of said tool and for causing rotational
movement of the tool.
2. A device as in claim 1 wherein said hand operated means includes
a handle member movable towards and away from the housing.
3. A device as in claim 1 wherein said handle assembly is formed so
that it is adapted to be engaged by the human hand and to be held
in a generally vertical position and a trigger handle movable in a
direction generally perpendicular to the vertical position.
4. A device as in claim 3 wherein said handle assembly includes
means for mounting said trigger handle so that it moves in a
parallelogram-like fashion.
5. A device as in claim 3 together with means carried by the
housing adapted to be grasped by the thumb of the human hand so as
to provide a counterforce to the finger actuation of the hand on
the trigger handle.
6. In a hand-held surgical assembly for use in performing a
laparoscopic medical procedure, a hand-held endoscopy device having
distal and proximal extremities and having a bore extending
therethrough from the distal extremity to the proximal extremity,
said hand-held endoscopy device having a handle assembly adapted to
be grasped by the human hand, operable tool means removably mounted
in said bore of the device and having a proximal portion thereof
extending out of the proximal extremity permitting the same to be
grasped by the hand to aid in inserting the operable tool means
into the bore in the device and removal of the operable tool means
from the bore of the device, said operable tool means including
tool parts and an actuation mechanism for operation of the tool
parts, said operable tool means and said handle assembly including
cooperative means for establishing a substantially fluid-tight seal
in said bore between the handle assembly and said operable tool
means and hand-operated means carried by the handle assembly and
connected between the handle assembly and the operable tool means
to cause operation of the tool parts of the operable tool
means.
7. An assembly as in claim 6 together with an adapter removably and
rotatably secured to said operable tool means, said operable tool
means having a bore therein in communication with the bore in the
device, said adapter having a bore therein in communication with
the bore in said operable tool means, means carried by said
operable tool means for establishing a fluid-tight connection
between the bore in said operable tool means and the adapter.
8. An assembly as in claim 7 further including switch means carried
by the device for causing a liquid to be delivered to the bore in
said device or alternatively to provide a vacuum to the bore in
said device.
9. An assembly as in claim 7 further including switch means carried
by the device for supplying electrical energy to the operable tool
means to perform electrocautery operations and electrical cable
means carried by the adapter and connected to said switch
means.
10. A device as in claim 1 wherein said tool parts are in the form
of serrated jaws.
11. A device as in claim 10 wherein said serrated jaws are formed
of a metal and further including a covering mounted on said jaws
and having spaces therein exposing the metal of the jaws.
12. A device as in claim 11 wherein said tool parts are in the form
of opposed clam shells.
13. A device as in claim 12 wherein said clam shells have exposed
exterior surfaces and metal knife-like edges and further including
insulating material covering substantially all of the exterior
surfaces of the clam shells but excluding the knife-like edges.
14. A device as in claim 6 wherein one of said tool parts is
provided with a hook-like portion.
15. In a method for performing a medical procedure in a patient by
the use of a hand-held endoscopy device having a bore extending
therethrough and a plurality of surgical tools, introducing the
endoscopy device into the patient, introducing one of the surgical
tools through the bore in the endoscopy device and performing
electrocautery operations during the time that the tool is in place
in the hand-held endoscopy device, removing the tool after the
medical procedure has been completed and thereafter removing the
hand-held endoscopy device from the patient.
16. A surgical tool for use with a hand-held endoscopy device
comprising an elongate tubular member having proximal and distal
extremities, first and second jaw members pivotally mounted on the
distal extremity of said elongate tubular member, means carried by
the elongate tubular member for moving the first and second jaw
members between open and closed positions, said first and second
jaw members being formed of metal and molded coverings formed on
the said jaw members formed of a durable hard plastic material and
having serrations therein.
17. A tool as in claim 16 wherein said plastic material is a
polymeric material.
18. A tool as in claim 16 wherein said covering is formed to
provide spaces therebetween to expose the metal of the jaws so that
the tool can be utilized for electrocautery.
19. A tool as in claim 18 wherein said serrations extend
transversely of the jaws and wherein said coverings are formed to
provide an elongate space extending longitudinally of the jaws.
Description
This invention relates to a hand-held surgical device and tools for
use therewith, an assembly and method, and more particularly to
such a device, tools, assembly and method for use in performing
medical procedures.
Surgical devices for use in endoscopic procedures have heretofore
been provided. These typically, however, have been separate
individual devices or tools used independently. This is
particularly true for tools for use in laparoscopy in which the
tools usually have been expensive, fine precision metal tools.
There is therefore a need for tools which are much less expensive
which can be made disposable if so desired, and which can be
utilized in conjunction with a hand-held surgical device.
In general, it is an object of the present invention to provide a
hand-held surgical device and tools for use therewith, an assembly
and a method for utilizing the same.
Another object of the invention is to provide a device of the above
character which is provided with a hollow bore through which the
tools can be inserted.
Another object of the invention is to provide a device of the above
character in which the device includes a trigger mechanism for
causing a linear thrusting motion which is utilized for actuating
tools disposed in the bore of the device.
Another object of the invention is to provide a device of the above
character in which the device includes a scissors-like mechanism
for causing a linear thrusting motion which is utilized for
actuating tools disposed in the bore of the device.
Another object of the invention is to provide a device of the above
character in which the bore extends through a slidably mounted
sleeve or barrel.
Another object of the invention is to provide a device of the above
character in which the sleeve can be rotated.
Another object of the invention is to provide a device of the above
character in which the tools can be locked onto the device for
actuation of the tools and for rotation of the tool.
Another object of the invention is to provide a device of the above
character in which tools can be readily inserted and removed.
Another object of the invention is to provide a device and tools
for use therewith of the above character in which substantially
fluid-tight seals are created between the tool and the device when
a tool is inserted in the device.
Another object of the invention is to provide a device and tools
for use therewith of the above character in which spring-loaded
members are utilized.
Another object of the invention is to provide a device and tools
for use therewith of the above character with which electrocautery
operations can be performed.
Another object of the invention is to provide a device and tools
for use therewith in which the tools can be made disposable if
desired.
Another object of the invention is to provide a device of the above
character which can be sterilized.
Another object of the invention is to provide a device of the above
character which is particularly suited for use in gynecological
surgical procedures.
Another object of the invention is to provide a device of the above
character which has been simplified and which has been provided
with fewer functions to be used by a surgical assistant.
Another object of the invention is to provide a device of the above
character which can be utilized by a surgical assistant which
excludes electrical and fluid functions.
Another object of the invention is to provide a device of the above
character which has a long lifetime and which has lower maintenance
costs.
Additional objects and features of the invention will appear from
the following description of the particular embodiment as set forth
in detail in conjunction with the accompanying drawings:
FIG. 1 is a side elevational view of hand-held surgical device
incorporating the present invention.
FIG. 2 is a top plan view looking along the line 2--2 of FIG.
1.
FIG. 3 is a rear elevational view looking along the line 3--3 of
FIG. 1.
FIG. 4 is a cross-sectional view taken along the line 4--4 of FIG.
2.
FIG. 5 is a cross-sectional view taken along the line 5--5 of FIG.
4.
FIG. 6 is a cross-sectional view taken along the line 6--6 of FIG.
4.
FIG. 7 is a cross-sectional view taken along the line 7--7 of FIG.
4.
FIG. 8 is a cross-sectional view taken along the line 8--8 of FIG.
1.
FIG. 9 is a cross-sectional view taken along the line 9--9 of FIG.
1.
FIG. 10 is a side elevational view of a tool incorporating the
present invention.
FIG. 11 is a cross-sectional view of the tool shown in FIG. 10.
FIG. 12 is a cross-sectional view taken along the line 12--12 of
FIG. 11.
FIG. 13 is a partial cross-sectional view of a device incorporating
the present invention with a tool mounted therein.
FIG. 14 is a partial side elevational view partly in cross-section
of the distal extremity of a tool incorporating the present
invention.
FIG. 15 is a top plan view of the tool shown in FIG. 14 looking
along the line 15--15 of FIG. 14.
FIG. 16 is a cross-sectional view taken along the line 16--16 of
FIG. 14.
FIG. 17 is a cross-sectional view taken along the line 17--17 of
FIG. 14.
FIG. 18 is a side elevational view of a distal extremity of another
tool incorporating the present invention.
FIG. 19 is a view looking along the line 19--19 of FIG. 18.
FIG. 20 is a view of the distal extremity of another tool
incorporating the present invention.
FIG. 21 is a top plan view looking along the line 21--21 of FIG.
20.
FIG. 22 is a partial side elevational view of another tool
incorporating the present invention.
FIG. 23 is a plan view partially in cross-section looking along the
line 23--23 of FIG. 22.
FIG. 24 is a partial side elevational view of the tool shown in
FIG. 22 but of the side opposite that shown in FIG. 22.
FIG. 25 is a cross-sectional view taken along the line 25--25 of
FIG. 23.
FIG. 26 is a cross-sectional view of the distal extremity of
another tool incorporating the present invention.
FIG. 27 is a top partial plan view of another tool incorporating
the present invention.
FIG. 28 is a cross-sectional view taken along the line 28--28 of
FIG. 27.
FIG. 29 is a cross-sectional view of an adapter assembly for use
with a tool when it is inserted into an endoscopy device of the
present invention.
FIG. 30 is a side elevational view of an assembly incorporating the
present invention in which a tool is inserted into an endoscopy
device and in which an adapter assembly is mounted in the tool.
FIG. 31 is a side elevational view of a hand-held surgical device
incorporating another embodiment of the present invention utilizing
a scissors-type actuation mechanism.
FIG. 32 is a side elevational view similar to FIG. 31 with certain
portions broken away and shown in section.
FIG. 33 is an enlarged cross-sectional view taken along the line
33--33 of FIG. 32.
FIG. 34 is an enlarged cross-sectional view taken along the line
34--34 of FIG. 32.
FIG. 35 is an enlarged cross-sectional view taken along the line
35--35 of FIG. 32
FIG. 36 is an enlarged schematic view showing the manner in which
the portion of ratchet mechanism shown in FIG. 35 operates.
FIG. 37 is an enlarged cross-sectional view of the nose cone
portion of the device shown in FIG. 32.
FIG. 38 is a side elevational view incorporating another embodiment
of a hand-held device particularly suitable for use by a surgeon's
assistant.
FIG. 39 is a side elevational view of the device shown in FIG. 37
with a tool mounted therein and with certain parts broken away to
shown certain parts in section.
FIG. 40 is a cross-sectional view taken along the line 40--40 of
FIG. 39.
FIG. 41 is a cross-sectional view taken along the line 41--41 of
FIG. 39.
FIG. 42 is an exploded isometric view of the device shown in FIG.
37.
FIGS. 43A, 43B and 43C are schematic representations showing the
various modes of operation of the ratchet mechanism used in the
device shown in FIG. 44.
FIG. 44 is a side elevational view of another embodiment of a
hand-held surgical device incorporating the present invention
particularly suitable for gynecological surgical procedures.
FIG. 45 is a side elevational view of the device shown in FIG. 43
with certain portions broken away.
FIG. 46 is a cross-sectional view taken along the line 45--45 of
FIG. 44.
FIG. 47 is a cross-sectional view taken along the line 46--46 of
FIG. 44.
FIG. 48 is a cross-sectional view taken along the line 47--47 of
FIG. 44.
In general, the hand-held surgical assembly for use in performing a
medical procedure is comprised of a hand-held endoscopy device
having a bore extending therethrough. It also consists of a tool
removably mounted in the bore. Cooperative means is provided for
establishing a substantially fluid-tight seal between the bore and
the tool. An adapter assembly is mounted on the tool.
More in particular, as shown in the drawings of FIGS. 1-9, the
hand-held surgical device 31 consists of a housing 32 which is
provided with an upper cylindrical portion 33 and a handle portion
34 in the form of a pistol grip adapted to be grasped and held by a
single human hand. The housing 32 is preferably formed of a
material which can repeatedly withstand autoclave sterilization,
ethylene oxide sterilization or gamma radiation sterilization. One
material found to be particularly suitable for this purpose is a
plastic identified as Ultem, manufactured by the General Electric
Company. Such a material is capable of withstanding high
temperatures and is very durable. The housing 32, utilizing such a
plastic, is formed in two parts 32a and 32b (see FIG. 3) which are
joined together along a parting line 36. A pair of spaced apart
bosses 37 (see FIG. 4) are provided on each of the parts 32a and
32b so that the two parts 32a and 32b can be fastened together by
suitable means such as screws 38 extending into the bosses and
forming the two parts 32a and 32b into a unitary housing 32.
An actuator tube assembly 41 is mounted in the upper cylindrical
portion 33 for limited axial movement. The actuator tube assembly
41 is provided with a bore 42 which extends therethrough. The
actuator tube assembly 41 consists of two tubes 43 and 44 in which
tube 43 is formed of a suitable plastic such Ultem, hereinbefore
identified, and the tube 44 is formed of a suitable metal such as
stainless steel. The metal tube 44 has its proximal extremity fixed
within the distal extremity of the plastic tube 43 so that the bore
42 is continuous and has the same diameter extending from the
plastic tube 43 into the metal tube 44. The actuator tube assembly
41 is provided with proximal and distal extremities 46 and 47.
These proximal and distal extremities 46 and 47 are axially guided
within the housing by sidewise extending guide portions 48 and 49
(see FIG. 6) formed integral with the housing parts 32a and 32b
having semicircular recesses 51 which are adapted to receive the
proximal extremity 46 of the actuator tube assembly 41. Similarly,
upper and lower guide portions 53 (see FIG. 4) formed integral with
the parts 32a and 32b and having semicircular recesses 54 guide the
distal extremity 47 of the actuator tube assembly 41. Means is
provided for rotating the actuator tube assembly 41 about its axis
and consists of a thumb wheel or knob 56 (see FIGS. 1 and 4) which
encircles the actuator tube assembly 41 and which extends through a
slot 57 provided in the housing 32 so that the thumb wheel or knob
56 can be actuated by a finger of the hand while the hand is
holding the pistol grip-shaped handle portion 34. The thumb wheel
56 is provided with spaced apart, axially extending raised portions
58 to facilitate frictional engagement by a finger of the wheel or
knob 56. Cooperative mating means is provided between the thumb
wheel 56 and the plastic tube 43 of the actuator tube assembly 41.
The cooperative mating means consists of a pair of diametrically
spaced apart axially extending keys 61 which are slidably mounted
in the slots 62 extending diametrically outwardly from a bore 63
provided in the thumb wheel 56. The thumb wheel 56 is retained in a
fixed longitudinal position with respect to the actuator tube
assembly 41 by the guide portions 53 and wall portions 64 formed
integral with the housing parts 32a and 32b, and having
semicircular recesses 66 (see FIG. 4).
Means is provided for causing reciprocatory movement of the
actuator tube assembly 41 for a suitable distance, as for example
125 and consists of yoke-like lever arm 71 formed of a suitable
plastic such as Ultem. The yoke-like member 71 is provided with a
pair of pins 72 extending from opposite sides thereof that are
pivotally mounted in recesses (see FIG. 7). As can be seen, the
pins 72 are provided at the upper extremity of the lever arm formed
by the member 71 to provide a substantial mechanical advantage, as
for example a 4-to-1 mechanical advantage. The upper extremity of
the yoke-like lever arm 71 is provided with a U-shaped or forked
portion 76 having generally circular upper extremities 77 (see FIG.
4), which are disposed on opposite sides of the plastic tube 43
between circumferentially extending spaced apart flanges 78 and 79
provided centrally of the plastic tube 43 of the actuator tube
assembly 41. As can be seen from FIG. 4, the upper circular
extremities 77 fit relatively closely within the flanges 78 and 79.
The lower extremity of the yoke-like lever member 71 is pivotally
connected to a trigger bar 81 by pin-and-slot connections in which
elongate slots 82 are provided on opposite sides of the yoke-like
member 71 that receive the opposite extremities of a pin 83 mounted
in the trigger bar 81. The trigger bar 81 is mounted within the
housing 32 for movement in a direction which is substantially
parallel to the axis of the actuator tube assembly 41. The trigger
bar 81 travels between upper and lower wall portions 86 and 87
which are formed integral with the housing parts 32a and 32b (see
FIG. 5). In addition, the trigger bar 81 is guided by upper and
lower guide portions 88 and 89 also formed integral with the
housing parts 32a and 32b and which extend inwardly and slidably
seat in grooves 91 and 92 provided on opposite sides of the trigger
bar 81.
Spring means is provided for yieldably urging the trigger bar 81 to
the left as viewed in FIG. 4 and consists of a leaf-spring 96 which
has one leaf 97 engaging the interior of the housing 32 and the
other end 98 engaging the lower extremity of the yoke-like member
71. The apex 99 of the spring can be secured if desired to the
interior of the housing 32 by a screw 101. Means is provided for
limiting the travel of the trigger bar 81 to the left in the
housing 32 as viewed in FIG. 4, and consists of the yoke-like
member 71 which restrains movement of the trigger bar 81 because of
the limitations in axial movement of the actuator tube assembly 41
in the upper cylindrical portion 33.
The trigger bar 81 is provided with means whereby it is adapted to
be grasped by fingers of the hand holding the handle portion 34.
Such means consists of an elongate finger hole 106 which extends in
a direction which is generally perpendicular to the axis of
movement of the actuator tube assembly 41. It preferably is a size
which is adapted to receive at least two fingers of the hand, as
for example the two fingers between the index finger and the little
finger or the index and middle fingers of the hand.
Means is provided for retaining the trigger bar 81 in a
predetermined position against the force of the yieldable means
provided by the leaf spring 96 and consists of elongate sawtooth
portions 109 which are provided on opposite sides of the trigger
bar 81. The portions 109 are adapted to be engaged by plungers 111
seated in a well 112 and extending through a hole 113 provided in
the housing 32. Each of the plungers 111 is provided with two
portions 111a and 111b with a space 114 therebetween and an annular
recess 115 so that the portions 111a and 111b can be pressed
together and snapped through the hole 113 and retained therein. The
distal extremity of the plunger portion 111a is provided with
sawteeth 116 which are adapted to engage the sawteeth of the
sawtooth portions 109. A wave washer 117 is provided in each of the
wells 112, and is utilized for yieldably returning the
finger-operated plunger 111 into an out-of-engagement position.
When the plunger 111 is engaged by a finger of the hand, as for
example by the thumb on one side or the index finger on another
side, the plunger 111 can be pushed inwardly against the force of
the wave washers or springs 117 to cause the sawteeth 116 to engage
the sawtooth portions 109 to retain the trigger bar 81 in a
predetermined position. As soon as the sawtooth are engaged, the
frictional engagement is sufficient to prevent the wave washers
from returning a plunger 111 to its home position. It is only when
the trigger bar 81 is moved that the wave washers 117 will cause
the sawteeth 116 to disengage and to permit a plunger 111 to return
to its home position.
The surgical device 31 also includes a barrel 121 which is provided
with a bore 122 extending axially thereof and through the barrel
121. The barrel 121 can be formed of a suitable material such as
stainless steel. The bore 122 can be of a suitable size, as for
example 8 mm. However, it should be appreciated that in connection
with the present invention different barrels with different size
bores can be provided, as for example ranging from 6 to 12 mm
bores. The barrel can have a suitable length, as for example 8 to
14 inches. It is provided with a distal extremity 123 and a
proximal extremity 124. The proximal extremity 124 is mounted
within an adapter 126 of Ultem in the form of a reducer that is
mounted in a metal tube 127 of a larger diameter. The diameter of
the metal tube 127 is such so that the distal extremity of the
metal tube 44 can slidably fit therein to provide a substantially
fluid-tight seal between the same, to in effect form a
trombone-type seal permitting the axial movement of the actuator
tube assembly 41. The adapter 126 also forms a fluid-tight seal
between the barrel 121 and the metal tube 127. The metal tube 127
is mounted in a fixed position with respect to the housing 32 and
is frictionally retained therein as shown particularly in FIGS. 4
and 8.
A nose cone 131 formed of a suitable material such as Ultem is
mounted over the barrel and serves to reinforce the connection
between the barrel and the adapter 126 as well as the metal tube
127. The nose cone 131 is threadedly mounted as shown on the distal
extremity of the housing 32.
The bore 42 is in axial alignment with the bore 122 provided in the
barrel 121 and is adapted to receive tools of various types as
hereinafter described. Cooperative means is provided for
establishing a fluid-tight seal between the tool and the bore 32
and, as shown in FIGS. 4 and 8, consists of valve means in the form
of a valve member of the type described in U.S. Pat. No. 5,141,498
dated Aug. 25, 1992. This valve member 136 is seated within a
cylindrical enlargement 137 provided at the proximal extremity 46
of the plastic tube 43. A cylindrical cap 138 is threaded onto the
cylindrical enlargement 137 (see FIG. 8) to retain the valve member
136 in place. The cap 138 is provided with an annular shoulder 139
which engages the valve member 136 and holds it in place. The
annular shoulder 139 is provided with serrations 140 on the
proximal surface of the shoulder 139. The cap 138 is provided with
a hole 141 which is in registration with the bore 42. The cap 138
is provided with a bore 142 in alignment with the hole 141. An
annular recess 143 is provided within the bore 142.
The housing 32 is also provided with switching capabilities in the
form of a switch 151 on the top of the housing 32 which serve
electrocautery functions. Switch 151 has three positions, a
"central or off" position, and two depressed or "on" positions on
opposite sides of the central position. One side of switch 151 is
for higher power for cutting and the other side of switch 151 is
for lower power for coagulation. Control switches 153 and 154 are
provided on opposite sides of the housing in general alignment with
the switch 151 and also have three positions the same as switch
151. One side of control switch 153 can be utilized for controlling
the introduction of fluids through the bore 42, as for example a
saline or other irrigating solution which can be utilized for
irrigating and cleansing the area of interest. The other side
control switch 153 can be utilized to provide suction in the bore
42 to extract fluids, as for example saline solutions, which have
been introduced for irrigation purposes as well as blood, bile,
etc. The switch 154 can be utilized for controlling the same
functions as switch 153. It can be seen that the switch 151 and the
switch 153 have been positioned on the housing so that they can be
readily depressed by the index finger on the right hand while the
surgical device 31 is being held by the right hand. Similarly the
switch 151 and switch 154 can be depressed by the index finger of
the left hand when the surgical device 31 is being held by the left
hand.
As hereinbefore pointed out the endoscopic device 31 is adapted to
be used with tools of the type hereinafter described. In connection
with such tools, cooperative mating means is provided whereby the
tool is retained within the bore 42 and consists of L-shaped
recesses 161 which are formed exteriorly on the cylindrical
enlargement 137 of the tube 43. These recesses 161 are adapted to
mate with cooperative mating means provided on the tool as
hereinafter described. By utilizing cooperative mating means of
this type in form of a bayonet-type connection, a tool can be
inserted into the bore 42 and locked in place with a small
rotational movement. It also can be readily removed by unlocking
with a small rotational movement in an opposite direction and
subsequent withdrawal.
As hereinafter described, a plurality of tools are adapted to be
utilized with the endoscopic device 31. One of such tools is shown
in FIGS. 10, 11 and 12. This tool 166 as shown therein consists of
an elongate inner tubular member 167 which is provided with a bore
168 extending axially thereof and therethrough. The inner elongate
tubular member can be formed of a suitable material such as
stainless steel and can have a suitable exterior diameter such as 3
to 10 mm and by way of example 7 mm, and a suitable interior
diameter of 2 to 9 mm and by way of example 6 mm. The tubular
member 167 can have a suitable length, as for example ranging from
12 to 20 inches. It is provided with proximal and distal
extremities 169 and 171.
A locking and actuation mechanism 172 is mounted on the proximal
extremity 169. This mechanism 172 consists of an outer sleeve which
is slidably mounted on the proximal extremity 169 of the inner
tubular member 167. The proximal extremity of the sleeve 173 is
fixed to a slider clip 174. The slider clip 174 is formed of a
suitable material such as plastic and is provided with a serrated
annulus 175 on its distal extremity adapted to engage the
serrations 140 on the cap 138 of the hand held surgical device 31,
the slider clip 174 is provided with a pair of arms 176 spaced
180.degree. apart extending parallel to the axis of the sleeve 173.
Additional arms 176 can be provided if a further distribution of
linear forces is desirable. The arms 176 are substantially L-shaped
and are provided with laterally extending legs 177 which extend
into slots 178 provided in a cylindrical slider cap 179. The legs
177 are also provided with protrusions 180 which are rectangular in
cross-section and extend outwardly so that they are adapted to seat
in the annular recess 143 in the cap 138 as hereinafter described.
The cylindrical slider cap 179 is provide with an inwardly and
distally extending skirt 181 that is secured to the proximal
extremity of the inner tubular member 167. Yieldable means in the
form of a coil spring 182 is provided on the proximal extremity of
the inner tubular member 167 and has one end engaging the skirt 181
and has the other end engaging the slider clip 174 (see FIG.
11).
An outer sleeve 183 formed of a suitable material such as Ultem is
coaxially mounted on the slider cap 179 and engages a shoulder 184
provided on the slider cap 179, and is maintained in engagement
therewith by a friction fit. The outer surface of the outer sleeve
183 is provided with an annular groove 186 which is arcuate in
cross-section, as shown particularly in FIG. 10, that is disposed
between the proximal and distal extremities of the outer sleeve
183. As shown in FIG. 11, the proximal extremity 187 is provided
with an annular inclined surface 188 that overlies the outwardly
extending legs 177 provided on the slider arms 176 to control their
outward movement for purposes hereinafter described. The distal
extremity 189 is provided with inwardly extending cylindrical
protrusions 191 mounted thereon which are adapted to engage the
L-shaped recesses 161 provided in the surgical device 31 for
forming cooperative locking means between the same in the form of a
bayonet-type lock.
A linkage 196 is provided in the tool 166 for actuating mechanisms
of the type hereinafter described carried by the tool. This linkage
196 consists of a cylindrical pin 197 which extends diametrically
through elongate slots 198 provided in the inner tubular member 167
and into holes 199 provided in the sleeve 173. The slots 198 have
their elongations extending in the direction of the axis of the
inner tubular member 167. A link rod 201 is mounted within the bore
168 of the inner tubular member 167 and is provided with a hole 202
through which the pin 197 extends. The link rod 201 extends
distally from the pin 197 and is used for a purpose hereinafter
described. The pin 197 is retained within the holes 199 by a
plastic shrink tube 206 formed of a suitable heat-shrinkable
plastic and extending over the sleeve 173. Another piece of shrink
tube 207 is provided on the portion of the inner tube 167 which is
exposed beyond the distal extremity of the sleeve 173 and covers
all the distal extremity of the inner tubular member 167 except for
a gap 208 which is provided to permit slidable axial movement of
the sleeve 173 with respect to the tubular member 167. A mechanism
211 is mounted on the distal extremity of the inner tubular member
167 which is adapted to be operated by movement of the link rod 201
by sliding reciprocal movement of the outer sleeve 173 with respect
to the inner tubular member 167.
Sealing means is provided in the proximal extremity of the slider
cap 179 and consists of a valve member 216 of the type described in
copending application Ser. No. 07/757,343, filed Sep. 10, 1991,
which is clamped in place so that it is in generally axial
alignment with the bore 168 of the inner tubular member 167. The
valve member 216 is held in place by a cap 217 which threadedly
engages a cylindrical extension 218 of the skirt 181 of the slider
cap 179. A hole 219 is provided in the cap 217 which is in
alignment with the valve member 216 and the bore 168. The valve
member serves to form a substantially fluid-tight seal between the
cap and the open end of the bore 168 provided in the inner tubular
member 167.
The assembly 221 which is formed when a tool 166 is mated with an
surgical device 31 is partially shown in FIG. 13. This view shows
the manner in which the locking and actuator mechanism 172 of the
tool 166 cooperates with the proximal extremity of the surgical
device 31. The tool 166 is taken by one hand and the surgical
device 31 is grasped by the other hand. The distal extremity of the
tool is introduced through the bore 142 and through the valve
member 136 and enters into the bore 42 and thence into the bore 122
of the barrel 121. As the locking and actuator mechanism 172 is
advanced so that it comes into engagement with the proximal
extremity of the housing 32, the tool 166 is rotated until the
protrusions 191 come into engagement with the L-shaped recesses
161, then twisted slightly to lock the same into place by
bayonet-type connection. At the same time, the proximal extremity
of the cap 138 of the actuator tube assembly 41 is moved into the
space between the outer sleeve 183 and the legs 177 until the
protrusions 180 seat in the annular recess 143 of the cap 138 to
lock the cap 138 to the slider clip 174. The serrated annulus 175
engages the serrations 140 on the shoulder 139 so that the tool 166
will be rotated when the actuator tube assembly 41 is rotated. As
soon as this has been accomplished, the tool 166 has been locked
onto the endoscopy device 31 so that the tool 166 is longitudinally
fixed with respect to the endoscopy device 31. When the
spool-shaped outer sleeve 183 is locked onto the proximal extremity
of the housing 32 of the endoscopy device, the actuator tube
assembly 41 can be moved axially with respect to the outer sleeve
183 and can be rotated with respect thereto.
The actuator tube assembly 41 is actuated by movement of the
trigger bar 81 through the yoke-like member or lever arm 71 that
has the circular extremities 77 disposed between the flanges 78 and
79. Movement of the actuator tube assembly 41, which in turn
through its connection between the cap 138 and the protrusions 180
of the arms 176 seated in the annular recess 43 causes movement of
the sleeve 173. Movement of the sleeve 173 causes movement of the
pin 197 in the slots 198 in the inner tubular member 167 to cause
movement of the actuator rod 201. As pointed out previously, only a
relatively small amount of axial movement of the actuator tube
assembly 41 is required and it is for this reason that the slots
178 and the slots 198 are of a relatively short length. As
hereinafter explained, this movement is adequate to operate the
mechanism 211 provided on the distal extremity of the tool 166.
During the time that the movement of the sleeve 173 takes place,
the inner tubular member is held stationary by its engagement with
the skirt 181 which is connected by the bayonet-type connection
hereinbefore described to the housing 32 of the endoscopy
device.
Many of the tools 166 as hereinafter described utilize a common
actuation mechanism 231 shown in FIGS. 14-17 that consists of first
and second parallel links 232 and 233 which are pivotally connected
by a large rivet to the distal extremity of the link rod 201. The
other end of the link 233 is connected by a rivet 236 to the leg
237 of an L-shaped scissor blade 238. Similarly, the other end of
the link 232 is connected by a rivet 239 to a leg 241 of an
L-shaped scissor blade 242. The L-shaped scissor blades 238 and 242
are pivotally mounted on an Allen head screw 243 which is mounted
in a tool tip 246 formed of a suitable material such as stainless
steel.
The tool tip 246 is formed of parts 246a and 246b. Part 246a is
semicircular in form as shown in FIG. 16 and is provided with
cylindrical recesses 247 to accommodate the rod 201 to permit
reciprocatory movement of the rod 201 therein. The two parts 246a
and 246b are mounted in the distal extremity of the tubular member
267 by suitable means such as a crimp fit in the form of annular
grooves 248 in the distal extremity of the inner tubular member 167
as shown particularly in FIG. 14. The inner surfaces of the annular
grooves 248 frictionally engage the tool tip 246 to retain it in
place. The distal extremity of the tool tip 246 is provided with a
slot 251 in which the blades 238 and 242 are disposed and which are
connected to the links 232 and 233 in the manner hereinbefore
described. The part 246b is provided with a well 252 which receives
the Allen head screw 243 which is threaded into the part 246a a
shown in FIG. 17 to thereby permit pivotal movement of the blades
238 and 242 with respect to the screw 243.
When a tool 166 is free and not disposed within an endoscopy device
31, the yieldable spring 182 will push the rod 201 in a direction
towards the distal extremity to the solid-line position shown in
FIG. 14 so that the blades 238 and 242 are in the closed position
as shown in solid lines. When the tool is placed in the endoscopy
device as hereinafter described, the sleeve 173 is moved proximal
with respect to the tubular member 167 against the force of the
yieldable spring 182 to move the rod 201 towards the proximal
extremity to thereby move the rivets 234 to the right as viewed in
FIG. 14 to cause the jaws 238 and 242 to be moved to the open
dotted-line position shown in FIG. 14. Thereafter, the trigger bar
81 can be moved to actuate the rod 201 to move the scissor blades
238 and 242 to the closed position to perform cutting operations as
hereinafter described.
Another tool 256 is shown in FIGS. 18 and 19 which has a proximal
extremity which is substantially identical to the tool 166
hereinbefore described. The distal extremity is provided with an
actuation mechanism 231 of the type utilized in the tool 166 in
which L-shaped jaws 257 and 258 pivotally mounted on the screw 243
replace the L-shaped scissor blades 238 and 242. The jaws 257 and
258 are formed of a suitable material such as stainless steel and
are provided with molded coverings 261 and 262 formed of a suitable
material such as a hard durable polymeric material. These coverings
261 and 262 are provided with spaced apart serrations or teeth 263
extending transversely of the jaws 257 and 258. As shown in FIG.
19, the molded coverings 261 and 262 are formed to leave an
elongate annular space 264 extending longitudinally of the jaw
exposing the stainless steel jaws so that electrocautery functions
can be performed as hereinafter explained. Similarly, a space 264
can be provided on the opposite side of the jaw also to serve
electrocautery purposes.
Another tool 266 utilizing the actuation mechanism 231 hereinbefore
described is shown in FIGS. 20 and 21 and is provided for obtaining
biopsy samples. In this tool 266, oval-shaped clam shells 267 and
268 are provided which are pivotally mounted on the screw 243 and
which are provided with lever arms 271 and 272 which are connected
to the rivets 236 and 239. The clam shells 267 and 268 are formed
of a suitable material such as stainless steel. The outer surfaces
of the clam shells 267 and 268 can be covered by a layer 276 of an
insulating material so that all that remains uncovered is a
knife-edge like rim 277 on each of the clam shells to provide a
space 278 therebetween through which electrical contact can be made
to tissue to perform electrocautery operations as hereinafter
described.
In FIGS. 22, 23 and 24 there is shown another tool 281. In this
embodiment of the tool, the link member is in the form of a tubular
sleeve 282 replacing the rod 201. The tubular sleeve 282 is
slidably mounted within the inner tubular member 167 and has its
proximal extremity secured to the pin 197 (see FIG. 23) so that as
the pin 197 is moved longitudinally in the inner tubular member 167
the sleeve 282 will also be moved. A combination hook and scissor
device 286 is mounted on the distal extremity of the inner tubular
member 167. This hook and scissor device 286 consists of a fixed
part 287 and a movable part 288. The fixed part 287 is provided
with a knife edge 291 which is slightly offset upwardly as viewed
in FIG. 24 from a line perpendicular to the axis of the inner
tubular member 167. The knife edge 291 faces forwardly toward a
notch 292 provided in the fixed part 287. The distal or forward
extremity of the fixed part 287 is provided with a rounded distal
extremity 293. The fixed part 287 is semi-circular in cross section
as show in FIG. 25 and is fixed to the distal extremity of the
inner tubular member 167 by suitable means such as solder (not
shown). The movable part 288 is provided with a hook 296 on its
distal extremity. The hook 296 is provided with a portion 296a
which extends proximally into a cut out 297. The hook 296 is
provided with a cutting edge 298 which extends perpendicular to the
axis of the inner tubular member 167 which cooperates with the
knife edge 291 provided on the fixed part 287. The movable part 288
is secured to the movable sleeve 282 and if desired can be formed
integral herewith. A space 299 (see FIG. 23) is provided within the
inner tubular member 167 to permit movement of the distal extremity
of the sleeve 282 with respect to the proximal extremity of the
fixed part 287. Placement of the tool 281 within the endoscopy
device 31 causes the sleeve 282 to move to the left as viewed in
FIG. 23 so as to move the cutting edge 298 across the knife edge
291 to the dotted-line position shown in FIGS. 22, 23 and 24.
A bore 301 is provided in the sleeve 282 and makes it possible to
supply a liquid saline solution into the scissor device 286 in a
manner hereinafter described.
Another tool 306 is shown in FIG. 26 in which the proximal
extremity is similar to that hereinbefore described with respect to
the tool 166 with the exception that the pin 197 has been
eliminated. In this device, a right angle hook 307 formed of a
suitable material such as stainless steel is provided. The hook 307
is mounted in the distal extremity of the inner tubular member 166
in a suitable manner such as by bonding the same into an insert 308
frictionally disposed within the distal extremity of the inner
tubular member 167. The insert 308 is provided with a bore 309 that
is in communication with the bore 168 in the inner tubular member
167 so that saline solutions can be introduced or suction can be
applied to the bore 309 and the bore 168 during use of the tool
306.
Another tool 311 is shown in FIGS. 27 and 28 and serves as a
spatula. It is provided with a spatula 312 in the form of a
duckbill as shown in FIG. 27. The spatula 312 is formed of a
suitable material such as stainless steel. It can be formed as a
separate part or formed integral with a stainless steel cylindrical
insert 313 which is frictionally retained within the distal
extremity of the inner tubular member 167. The spatula 312
alternatively can be formed as a separate piece which can be welded
to the cylindrical insert 313. It is inclined upwardly and toward
the central axis of the tubular member 167 as shown in FIG. 28.
Insert 313 is provided with a bore 314 which is in communication
with the bore 168 in the inner tubular member 167 so that the
saline solution can be introduced through the bore 314 or
alternatively suction can be applied through the bore 314.
An adapter assembly 316 which is a type which can be utilized with
the tools hereinbefore described and particularly with respect to
tool 311 shown in FIGS. 27 and 28 is shown in FIG. 29. This adapter
assembly 316 consists of a cylindrical sleeve 317 formed of a
suitable material such as stainless steel which is provided with a
hub 318. A cylindrical bore extends through the cylindrical sleeves
317 and into the hub 318. Fittings 321 and 322 are mounted on the
hub 318 and are provided with flow passages 322, 323 and 324 that
are in communication with the bore 319. A covering 226 formed of a
suitable insulating material such as plastic is provided over the
hub 318 and has molded therein an electrical cable 327 that is
provided with multiple conductors as for example seven which extend
to a multiple-pin connector 328. The electrical cable 327 also
carries another high voltage conductor wire 329 which is utilized
in electrocautery procedures as hereinafter described and is
electrically connected to the hub 318 by suitable means such as by
a solder joint 331. The distal extremity of the cylindrical sleeves
317 is swaged outwardly as shown in FIG. 29 to hold the adapter
assembly 36 in place in a tool as hereinafter described. Means is
provided for making electrical contact between the inner tubular
member 167 and the sleeve 317 and consists of another sleeve 332
formed of a suitable material such as brass which is disposed on
the exterior surface of the cylindrical sleeve 317 and extends from
the hub 318 to the swaged portion 317a. The sleeve 332 is provided
with an annular bulge-like portion 332a to facilitate making
electrical contact with the inner tubular member 167 while
permitting rotation of the inner tubular member 167 with respect to
the sleeve 332.
As shown in FIG. 30, the adapter assembly 16 is adapted to be
mounted in the tool 311 and can be advanced through the hole 219 in
the cap 17 through the valve member 216 and into the inner tubular
member 267 so that the swaged portion 317 makes good electrical
contact with the interior of the inner tubular member 167. At the
same time, communication is established between the bore 319 and
the bore 168 of the tubular member 167. The connector 328 is
connected to the connector 157 provided on the endoscopic device
37.
As shown in FIG. 30, a control console 336 is provided for use with
the adapter assembly 316. The control console 336 is provided with
a microprocessor 337 and relay control assembly 338. The
microprocessor 337 and the relay control assembly 338 are connected
to a suitable source of power by a cable 339. The microprocessor
327 and the relay panel 338 are connected to the cable 327. The
relay panel 338 is also connected to electrical solenoids 341 and
342. The solenoids 341 and 342 are utilized for controlling the
flow of fluids to and from the adapter assembly 316. Thus solenoid
341 is provided with a tube 343 which is connected to the fitting
322 provided on the adapter assembly 316 and solenoid 342 is
provided with a tube 344 which is connected to the fitting 321 of
the adaptor assembly 316. The solenoid 341 is connected to a
suitable source of saline solution by a tube 346 and similarly the
solenoid 342 is connected to a source of vacuum by tube 347.
Operation and use of the hand held surgical device and tools for
use therewith, the assembly thereof and the method may now briefly
be described as follows. Let it be assumed that the patient has
been prepared and draped for performing a medical procedure, as for
example a laparoscopy for removing a diseased gallbladder. The
surgeon places a puncture in the abdomen with a small tool such as
a Veres needle. Carbon dioxide is introduced into this puncture to
cause a partial inflation of the abdomen to thereby create a cavity
in the abdominal area. The Veres needle can then be removed, and a
trocar can be introduced into the abdomen through the same puncture
or in a position adjacent to the needle. The trocar can be of a
conventional type or can be of the type described in U.S. Pat. No.
5,176,648 dated Jan. 5, 1993. With the trocar in place, additional
carbon dioxide is introduced into the abdomen to further inflate
the abdomen to a pressure corresponding to approximately 15 mm of
mercury. With the abdomen so inflated, an endoscope is inserted
into the abdominal cavity so that the interior of the abdominal
cavity can be visualized on a video monitor. Thereafter, three
additional trocars are positioned in the abdomen, one adjacent the
patient's upper left-hand portion of the abdomen, another at the
upper right-hand portion of the abdomen, and the third at the lower
right-hand portion of the abdomen. These additional sites are used
for introduction of various tools typically utilized during
endoscopic surgery. For example, the four trocars thus far
described would be utilized to remove a gallbladder. The surgeon,
after the trocar is in place, takes the endoscopy device 31 of the
present invention and grasps it by either his right hand or left
hand by grasping the pistol grip-handle portion 34. The surgeon
then positions the barrel 121 so that it can enter the trocar and
be advanced into the abdomen while the interior of the abdomen is
being visualized on the video monitor. The surgeon then selects the
desired tool to be utilized with the endoscopy device 31. For
example, the first tool the surgeon may select may be a grasper of
the type shown in FIGS. 18 and 19. With the grasper 256 locked in
place in the endoscopy device 31, the surgeon can manipulate the
grasper 256 to manipulate the liver and/or the gallbladder by
grabbing onto one of the organs and pulling on it or pushing on it
so that the desired positions of the organs are achieved to permit
the surgeon to perform the gallbladder removal procedure.
The grasper 256 in its normal position has its jaws 257 and 258 in
a closed position. With the jaws in the closed position, the
grasper can be inserted through the barrel 121 and the tool locked
in place by the cap 138 being advanced between the interior of the
slider cap 179 and the legs 76 until the protrusions 180 snap into
the annular recess 143 to lock the tool in place. This serves to
connect the tool mechanism to the trigger mechanism. Thereafter,
upon slight additional inward movement of the grasper 256 the
bayonet-type lock connection is made by the protrusions 202
entering into the L-shaped recesses 161 and then with a slight
grasper 256 it is locked into place. After this has been
accomplished, the trigger bar 81 can be operated by having the
fingers of the hand extend through the hole 106 to cause opening
and closing of the jaws 257 and 258. When the tool 256 is locked
into position as hereinafter described, the jaws 257 and 258 are
moved to an open position and thereafter can be opened and closed
by the surgeon operating the trigger bar 81.
Movement of the trigger bar from 1/2 to 5/8" causes approximately
1/8" of travel of the actuator tube assembly 41, which movement is
utilized to cause opening and closing of the jaws 257 and 258.
Because of the approximately 4-to-1 mechanical advantage which is
achieved, the application of one pound of force by the surgeon to
the trigger bar 81 will cause the application of approximately 4
pounds of force by the inside surfaces of the grasper jaws 257 and
258. The mechanism for operating the jaws 257 and 258 is one in
which pushing of the rod 201 serves to cause closing of the jaws
and pulling of the rod 201 causes opening of the jaws 257 and 258.
The mechanical advantage is maximized at the point of closure,
which is achieved by the pushing toggle action.
After the physician has positioned the liver and gallbladder in the
desired positions to achieve access to the desired anatomy, the
surgeon can then utilize another tool, as for example another
grasper 256, and insert it through one or the other ports to
dissect the fatty tissue which is connected to the gallbladder and
which is also connected to the cystic duct and to the cystic
artery. After the fatty tissue has been pulled away from the
desired ducts and arteries, the grasper 256 can be removed from the
endoscopy 31 device by giving a slight twist to the tool or grasper
256 to cause the protrusions 191 to move out of engagement with the
L-shaped slots 161 and then pulling the tool rearwardly. As the
tool is pulled rearwardly, the outer sleeve 183 with its inclined
surface 188 urges the arms 176 inwardly so that the protrusions 180
clear the annular recess 143 in the cap 138 to permit separation of
the tool from the endoscopy device 31. The tool can be readily
removed through the valve member 136 with the valve member 136
retaining a fluid-tight engagement with the tool and, after the
tool has been removed, to continue to form a fluid-tight seal with
respect to the bore 42 to prevent the escape of carbon dioxide.
Thereafter, the surgeon can take another tool such as a scissors
166 and insert it into the endoscopy device 31 in the same manner
in which the grasper tool 256 has been inserted and locked into
place. After this has been accomplished, the surgeon can operate
the trigger bar 81 of the scissors 166 to cause opening and closing
of the scissors to cut a pathway through the cystic duct.
A catheter (not shown) can then be introduced by the surgeon
through another trocar and advanced into the ductwork. A radiopaque
dye can then be introduced through the catheter into the ductwork,
and by viewing the same under x-ray the surgeon can ascertain
whether or not in fact he has cut the cystic duct. Assuming that
the cystic duct has been severed as desired, another tool can be
introduced through a trocar such as a clip applier to apply clips
to close the cystic duct. A similar procedure can be utilized for
cutting the artery and clipping the same. Once the cystic duct and
the artery have been legated, the doctor can cut through the cystic
duct and the artery without fear of causing internal bleeding. The
gallbladder can then be dissected from the liver by use of the
scissor tool 166, the hook 306 or the spatula 12.
In the removal of the gallbladder it may be desirable to use an
additional tool or another tool such as the spatula tool 311 shown
in FIGS. 27 and 28 with an adapter assembly 316 mounted thereon.
After the spatula tool 311 has been introduced into the endoscopy
device 31 and locked in place, the spatula 12 can be manipulated to
separate the gallbladder from the liver by physical separation
utilizing the spatula. Alternatively, electrocautery techniques can
be utilized in conjunction with the spatula 312 which by operation
of the switches 151 and 152 can be used to burn away the undesired
tissue and to perform electrocautery where necessary. The
electrical arcing created between the spatula and the tissue will
cut through and coagulate away the connective tissue between the
gallbladder and the liver. In this way, the gallbladder can be
systematically dissected free from the liver.
In the event that there is excessive bleeding or holes are cut into
either the gallbladder or the liver, it may be necessary to
cauterize and cleanse the area in order to permit the surgeon to
continue to visualize the operations being performed. This can be
readily accomplished by introducing a saline solution by operating
one of the switches 153 or 154 provided on the sides of the housing
32 of the endoscopy device. These switches can be operated by the
fingers of the hand holding the tool. Thus, first, a saline
solution can be introduced into the adapter assembly 316 through
the energization of the solenoid 341 to cause fluid to pass into
the bore 168 of inner tubular member 167 and through the bore 314.
Similarly, suction can be applied to these same passages by
energization of the solenoid 342 to cause the saline solution and
other liquids in the cavity to be withdrawn from the patient. This
can be readily accomplished because of the relatively
large-diameter flow passages provided for introducing liquids such
as saline solutions and removing liquids from the abdominal
cavity.
After the liquids have been removed from the cavity, the surgeon is
free to continue the procedure, as for example continuing
dissection or removal of the gallbladder from the liver.
After the gallbladder has been separated from the liver, it can be
removed from the abdominal cavity through one of the puncture
wounds which has been formed in the abdominal wall. Alternatively,
the surgeon can utilize a retrieval device such as that disclosed
in U.S. Pat. No. 5,190,555, dated Mar. 2, 1993, which can be
introduced through one of the punctures and the gallbladder and its
contents placed into the sack. The sack can then be closed and the
sack with its contents, namely the gallbladder, bile and stones,
can then be pulled through the abdominal puncture or wound. After
the gallbladder has been removed, the other trocars can be removed,
as well as the endoscope. The abdomen is then deflated or
desufflated. The puncture wounds in the abdomen are then closed
with one or more sutures.
In the procedure hereinbefore described, any of the tools
hereinbefore described can be utilized in the procedure, as for
example the hook scissors tool 286 shown in FIGS. 22-25. Many of
the tools can be utilized as electrocautery devices because of the
metal distal extremities can form electrical contact with the
tissue on which electrocautery operations are to be performed. As
explained previously, the adapter assembly 316 can be readily
secured to the tool while maintaining a fluid-tight connection with
the same through the valve member provided in the tool. Saline
introduction and suction operations also can be readily performed.
It should be appreciated that surgical device 31 and the tools
hereinbefore described can be constructed of non-ferrous materials
such as plastic, aluminum, brass, etc., thereby permitting them to
be used in conjunction with magnetic resonance imaging, x-rays, CT
scanning, ultrasound and other imaging techniques.
Another embodiment of a hand-hand surgical device 401 incorporating
the present invention is shown in FIGS. 31-36 which is provided
with a scissors-type hand actuation mechanism rather than a
trigger-type hand-actuator mechanism disclosed in the previous
embodiments of the hand-held surgical device. The surgical device
401 consists of a housing 402 formed in two parts 402a and 402b,
each of which has a cylindrical portion 403 and a descending handle
portion 404. The two parts 402a and 402b are adapted to be fitted
together in a suitable manner such as by push pins (not shown)
extending into holes (not shown) provided in the parts 402a and
402b. An actuator tube assembly 411 of the type hereinbefore
described is mounted in the upper cylindrical portion 403 for
limited axial reciprocatory movement. The actuator tube assembly
411 is provided with a bore 412 which extends therethrough. The
actuator tube assembly 411 is constructed with a trombone-like seal
in a manner substantially similar to that hereinbefore described
with the previous embodiments and thus will not be described in
detail.
The actuator tube assembly 411 extends through a rectangular
box-like electrical housing 416 mounted in the upper cylindrical
portion 403 of the housing 402 (see FIG. 32). The electrical
housing 416 is adapted to interact with a flex circuit (not shown)
of the type described in co-pending application Ser. No. 08/128,309
filed on Sep. 28, 1993. The flex circuit is connected to two
electrical switches 421 and 422 mounted on each of the opposite
sides of the housing 416 for "cut" and "coag" functions which are
adapted to be operated by push buttons 423 and 424 provided on
opposite sides of the cylindrical housing 403. The push buttons 423
and 424 are adapted to be operated by a finger of the human hand
holding the hand-held surgical device and having the other three
fingers extend through the arcuate slot 426 provided in the handle
portion 404. This arrangement makes the hand-held surgical device
401 ambidextrous so it can be operated equally well by left-handed
or right-handed persons. Two other electrical switches 428 for
irrigation and 429 for suction are carried by the electrical
housing 416 and extend upwardly through the cylindrical portion 403
and are used for controlling the introduction of saline solution
through a tube 431 connected to the device 401 and a tube 432 for
supplying suction to the device. These two switches are controlled
by a rocker switch arm 434 accessible from the top of the
cylindrical portion 403 of the housing 402 and also being adapted
to be engaged by the index finger of the hand holding the surgical
device 401.
Means is carried by the housing 402 for causing reciprocatory
movement of the actuator tube assembly 411 consists of a yoke-like
member 436 which is provided with rounded extremities 437 that
engage spaced-apart parallel annular flanges 438 and 439 carried by
the actuator tube assembly 411. The yoke-like member is provided
with handle portions 441 which extend through a slot 442 provided
in the cylindrical portion 403 of the housing 402 proximal of the
handle portion 404. The handle portions 441 are provided with holes
443 adapted to receive the thumb of the hand engaging the handle
portion 404.
The yoke-like member 436 is pivotally mounted in the cylindrical
portion 403 of the housing 402 by pin 444 formed of boss portions
444a and 444b which are seated in inwardly extending protrusions
446 provided as a part of the cylindrical portions 403a and
403b.
A nose cone 451 is disposed in the forward extremity of the housing
402. It is threaded onto a cylindrical nose bearing 452 (see FIG.
37). The nose bearing 452 is provided with an annular recess 453
into which the cylindrical portion 403 extends to permit
longitudinal movement of the actuator tube assembly 411. The nose
bearing 452 is mounted on the distal extremity of the actuator tube
assembly 411. Cooperative mating means is provided for causing
rotation of the actuator tube assembly 411 as the nose cone 451 is
rotated by a finger of the hand as for example by the index finger
as the hand-held surgical device 401 is held by a human hand. Such
cooperative mating means takes the form of a key and slot
connection in which a key 454 is carried by the nose bearing 453
and extends into an elongate slot 455 carried by the actuator tube
assembly 411 (see FIG. 37). This key and slot connection, in
addition to causing rotation of the actuator tube assembly 411
permits longitudinal or axial movement of the actuator tube
assembly relative to the nose cone 451. A nose bushing 456 is
slidably mounted on the distal extremity of the actuator tube
assembly 411 and is provided with a flanged portion 456a extending
beyond the distal extremity of the actuator tube assembly 411. This
flange portion is rotatably mounted in an annular recess 457
provided on the distal extremity nose cone 451. A cylindrical
barrel 458 is releasably retained within the nose bushing 456 by a
snap-in type of connection comprising an annular bead 459 which is
adapted to seat in an annular recess provided on the proximal
extremity of the barrel 458 (see FIG. 37). With the construction
hereinbefore described, it can be seen that the barrel 458 can
remain stationary when the nose cone 451 is being rotated for
causing rotation of a tool carried within the barrel 458 as
hereinafter described.
A passive ratchet mechanism 461 is provided for retaining the
actuator tube assembly 411 in a desired axial position as it is
advanced by operation of the thumb handle 441. This ratchet
mechanism 461 takes the form of a ratchet pawl 462 pivotally
mounted in a boss 403a (see FIG. 35) in the housing 402 by a pin
463 extending transversely thereof. Ratchet pawl 462 is adapted to
engage ratchet teeth 464 carried by an arcuate surface 466 provided
on the thumb handle 441.
A cam mechanism 468 is provided for causing the ratchet pawl 462 to
engage the ratchet teeth 464 and consists of push buttons 469
accessible from opposite sides of the housing 402. The buttons 469
have portions thereof extending through slots 471 connected to a
cam member 472 (see FIG. 36) which is movable sidewise in opposite
directions within the housing 402. The cam member 472 is provided
with a vee-shaped slot 473 with the legs thereof extending
downwardly formed therein. One end of the ratchet pawl 462 opposite
the pivot pin 463 extends into the vee-shaped slot (see FIGS. 35
and 38) and is centered at the apex of the vee-shaped slot. In this
position of the cam member 472, the pawl 462 is maintained out of
engagement with the ratchet teeth 464. A coil spring 474 is mounted
on the boss 403a and has an end 476 engaging another boss 477 on
the handle portion 404 and the other end 478 engaging a boss 479 on
the ratchet pawl 462. The coil spring 474 yieldably urges the cam
member 472 so that the apex of the vee-shaped slots brings the
ratchet pawl 462 to the central dotted-line portion shown in FIG.
36.
If it is desired to passively engage the ratchet teeth, either of
the buttons 469 can be engaged by a finger of the hand and the cam
member 472 is pushed sidewise. As this occurs, the end of the pawl
462 remote from the ratchet teeth is cammed downwardly with respect
to the pivot point 463 with the other end being cammed upwardly to
engage the ratchet teeth 464. Thus it can be seen that any time
that the device 401 is being utilized and the thumb is being
utilized for operating the thumb handle 441 to bring it in closer
proximity to the handle portion 404, the ratchet teeth are advanced
forwardly and the ratchet mechanism 461 can be utilized to retain
the thumb handle 441 in a desired position by merely engaging one
of the push buttons 469 to cause the end of the pawl 462 opposite
the portion of the pawl 462 engaging the teeth to be cammed
downwardly to move the pawl into engagement with the teeth to latch
the thumb handle 441 in a desired position. It can be seen that
this procedure can be accomplished either with a button on each
side depending on whether the person is right-handed or
left-handed. In both cases movement, because of the vee-shaped slot
472, the extremity of the ratchet pawl 462 therein will be cammed
downwardly against the force of spring 474 to urge the ratchet pawl
462 into engagement with the ratchet teeth 464. When it is desired
to release the pawl 462 from the ratchet teeth 464, it is merely
necessary to engage the thumb handle 441 and push on it slightly to
release the ratchet pawl 462 permitting the spring 474 to return
the cam member 472 to a central position and permitting the ratchet
pawl to remain disengaged. The thumb handle 441 can be released to
be yieldably returned to its home position in which the actuator
tube assembly 411 is located in a proximal position by a return
spring 486 which has one end secured within the thumb handle 441 in
a suitable manner such as by a pin 487 and which has the other end
secured to the housing 402 by a pin 488. As can be seen from FIG.
34, the return spring 476 extends through a hole 489 the thumb
handle 441.
Operation and use of the hand-held surgical device 401 is very
similar to that hereinbefore described in connection with the
previous embodiments. A tool 491 of the type hereinbefore described
can be inserted into the hand-held surgical device 401 in the
manner hereinbefore described and is retained therein. As explained
previously, the principal difference between hand-held surgical
device 401 and the one previously described is that it utilizes a
scissors-type grip rather than a pistol-type grip as disclosed in
previous embodiments. This feature is advantageous to many surgeons
because they are accustomed to utilizing scissors-type devices in
surgery. This makes it possible for the surgeon to utilize the same
type of action to which the surgeon is accustomed in performing
surgical procedures. The hand-held surgical device 401 is also
advantageous in that it can be utilized equally well by left-handed
or right-handed surgeons because the controls are accessible from
opposite sides and can be operated either by the left hand or the
right hand, depending upon which hand the surgeon desires to
use.
Another embodiment of a hand-held surgical device incorporating the
present invention which is particularly adapted to be utilized by a
surgical assistant is shown in FIGS. 38-42. The surgical device 501
consists of a housing 502 formed of two parts 502a and 502b and is
generally in the form of a truncated cone. The housing 502 is
provided with a finger recess 503 which is adapted to be engaged by
a finger of the hand when the hand-held surgical device 501 is held
by a human hand as hereinafter described.
An actuator tube assembly 506 is mounted for reciprocatory movement
within the housing 502 similar to the actuator tube assembly
hereinbefore described. It is provided with a bore 507 extending
therethrough which is adapted to receive surgical tools of the type
hereinbefore described. Handle or trigger means is provided for
axially moving the actuator tube assembly 506 in the desired
reciprocatory motion. The handle means consists of two parts which
are adapted to be joined together in a suitable manner as for
example by the use of push pins 512 extending into holes 513. The
forward extremities of the handle parts 511a and 511b are provided
with pivot holes 516 which are adapted to receive inwardly
extending pins 517 provided on upwardly extending protrusions 518
formed as a part of the housing 502. The forward extremities of the
handle parts 511a and 511b also carry downwardly extending
protrusions 521 which are disposed between parallel spaced apart
annular flanges 522 and 523 provided on the actuator tube assembly
506 for causing reciprocatory movement of the actuator tube
assembly 506 as the handle 511 is pressed towards the housing
502.
This reciprocatory movement of the actuator tube assembly 506 in a
proximal direction must be accomplished against the force of a coil
spring 526 coaxially mounted on the actuator tube assembly 506. The
coil spring 526 has one end engaging an annular flange 527 provided
on the actuator tube assembly 506 and has the other end engaging
inwardly extending arcuate protrusions 528 provided in the housing
502 (see FIG. 39). A cylindrical member 531 is threadedly mounted
on the proximal extremity of the actuator tube assembly 506 by
suitable means such as an adhesive (not shown). The cylindrical
member 531 is provided with a hole 532 therein which opens into the
bore 507 of the actuator tube assembly 506 so that surgical tools
of the type hereinbefore described can be inserted therethrough.
The cylindrical member 531 is provided with longitudinally
extending circumferentially spaced apart recesses 533 to aid in
gripping the cylindrical member 531 by the fingers of the hand.
Bayonet-type recesses 534 are provided on the exterior surface of
the proximal extremity of the housing 502.
A nose cone 536 of the type hereinbefore described provided with
circumferentially spaced protrusions 537 on the outer surface
thereof is rotatably mounted on the housing 502 and is secured
thereto to prevent longitudinal movement of the nose cone 536 with
respect to the housing 502. The housing 502 is seated in an annular
recess 538 provided in the nose cone 536 (see FIG. 40). Cooperative
mating means is provided on the nose cone 536 and the actuator tube
assembly 506 so that when the nose cone 536 is rotated by a finger
of the hand, the actuator tube assembly 506 will be rotated while
still permitting axial movement of the actuator tube assembly 506.
Such cooperative mating means includes a pin 539 carried by the
nose cone 536 and formed integral therewith which is disposed in an
elongate recess 541 provided on the actuator tube assembly 506 and
extending longitudinally thereof.
A ratchet pawl mechanism 551 is provided for retaining the actuator
tube assembly 506 in a desired axial position as it is being
advanced to actuate a tool carried by the device 501 as hereinafter
described. This ratchet pawl mechanism 551 includes a knob or lever
552 mounted in the handle 511 extending upwardly out of the handle.
This knob is adapted to assume three different positions as shown
in FIGS. 43A, 43B and 43C. The first position shown in FIG. 43A is
the "disengaged position" in which the ratchet knob 552 is proximal
or to the rear in which the ratchet pawl mechanism 551 is
deactivated permitting the trigger handle 511 to move unimpeded to
any position. The second or midpoint position shown in FIG. 43B is
the "passive" position in which the ratchet mechanism is passively
engaged as hereinafter described. The third position is shown in
FIG. 43C in which the ratchet knob is distal or forward and locks
the ratchet mechanism.
The trigger knob or lever 552 is formed integral with a generally
cylindrical body 553 which is disposed in a cylindrical recess 554
provided within the handle parts 511a and 511b and is pivotally
mounted therein on a pin 556 supported by the handle parts 511a and
511b. The body 553 is arcuate in shape and is provided with a
curved surface 557 which travels within the cylindrical recess 554.
A rounded protrusion or detent 558 is provided on the outer surface
and is adapted to engage a recess 559 formed in the handle or
trigger 511. An arcuate slot 561 is formed in the body 553 and
underlies the curved surface 557 to permit inward flexing of the
portion of the body overlying the curved arcuate slot 561 so as to
provide a spring member yieldably urging the detent 558 in an
outward direction so it will be yieldably urged into the recess 559
when the lever or knob 552 is operated to move the detent 558 into
registration with the recess 559. The body 553 is provided with a
radially extending depending tab 563 which is adapted to engage a
lip 564 carried by the upper extremity of a U-shaped pawl 566. The
U-shaped pawl 566 is provided with first and second legs 567 and
568 which are generally spaced apart and parallel with a lateral
extending portion 569 which carries the lip 564. Each of the legs
567 and 568 is provided with a hole 571 which is pivotally mounted
on a pin 572 carried on the inner surface of a downwardly and
proximally extending portion 573 of the handle 511.
A coil spring 576 (see FIG. 39) is provided and is mounted on the
pin 553 and is seated within an arcuate recess 577 (see FIG. 42)
provided in the body 553 and has one end 578 of the coil spring
engaging a surface 579 provided in the body 553 and has the other
end 581 extending through a small hole 582 provided in a transverse
portion 569 of the pawl 566 and serves as an action spring as
hereinafter described. Another coil spring 584 is provided which
extends over the end 581 of the spring 576 and has one end engaging
the top surface of the transverse portion 569 of the pawl 566 and
has the other end engaging the coil spring 576. The spring 584
serves as a return spring. The legs 567 and 568 of the pawl 566 are
provided with pawls 586 which are adapted to engage teeth 587
provided on inclined curved surfaces 588 of members 589 secured to
the housing 502 by suitable means such as screws 591.
An audio feedback system is incorporated into the hand-held
surgical device 501 and consists of longitudinally extending slots
593 which are provided on the actuator tube assembly 511 (see FIG.
39) immediately forward of the coil spring 526. The peaks and
valleys formed by these longitudinally extending slots 593 on the
actuator tube assembly 511 are engaged by a pin 594 yieldably urged
in toward the actuator tube assembly 511. The pin 594 extends
through a hole 596 provided in the member 589 carrying the teeth
587. The pin 594 is carried by flange sleeve 596 disposed on the
other side of the member 589 which is slidably mounted on a
cylindrical protrusion 597 carried by the housing part 502a. A coil
spring 598 is disposed on the sleeve and has one end engaging the
flange portion as shown in FIG. 41 and has the other end engaging
the inner surface of the body part 502a. With such a construction,
it can be seen that as the actuator tube assembly 506 is rotated,
click-click sounds will appear as the longitudinally extending
slots are rotated past the pin or plunger 594 to audibly inform the
surgeon of the rotation of the actuator tube assembly 506 and the
speed of rotation by the rapidity at which the clicks are heard by
the surgeon. The pin 594 also serves as a detent to yieldably
retain the actuator tube assembly 506 in a desired position when
the actuator tube assembly 506 is not being moved.
Operation and use of the hand-held surgical device 501 may now be
briefly described as follows. Let it be assumed that a laparoscopic
procedure is taking place and that the surgeon has an assistant who
is utilizing the hand-held surgical device 501 shown in the
drawings. Let it also be assumed by way of example that the
surgical assistant wishes to utilize the hand-held device for use
with a tool such as a grasper 599 having openable jaws 600. Let it
be assumed that a gall bladder laparoscopic procedure is being
performed and that it is desired to utilize the grasper 591 to pull
up and expose the gall bladder so that it can be surgically removed
by the surgeon performing the procedure. The assistant utilizes the
hand-held surgical device 501 to introduce the grasper 591 through
a trocar cannula (not shown) already introduced into the body of
the patient. During the introduction, the handle 511 is engaged by
the palm of the hand and the palm of the hand is utilized to hold
the housing 502 which serves as a support for the grasper 599. The
assistant compresses the handle 511 against the housing 502 to
close the jaws 600 of the grasper 599 and introduces the grasper
599 into the body cavity of the patient into the vicinity of the
gall bladder. The handle 511 can then be released to permit the
actuator tube assembly 506 to move proximally under the force of
the coil spring 526 to cause the jaws 600 of the grasper 599 to
open. The grasper 599 then can be advanced over the gall bladder
and the gall bladder clamped between the jaws 600 by using the
fingers of the hand to press downwardly on the handle 511 to cause
advancement of the actuator tube assembly 506 to cause closing of
the jaws in the manner hereinbefore described in the previous
embodiments.
Operation and use of the ratchet mechanism 551 provided in the
hand-held surgical device 501 may now be briefly described in
connection with the tasks being performed by the surgeon's
assistant. As pointed out above, the ratchet knob or lever 552 is
movable into three positions.
The surgeon's assistant during an initial introduction may wish to
hold the ratchet knob 552 and may wish to bring back the ratchet
knob to a proximal position so that the ratchet mechanism 551 is
inoperative as shown in FIG. 43A. Thereafter let it be assumed that
the grasper 599 has been moved into the vicinity of the gall
bladder with the jaws 600 in an open position. After the jaws 600
have been moved onto the gall bladder, the assistant may move the
ratchet knob 552 to an intermediate position to that shown in FIG.
43B in which the pawls 586 have been moved into engagement with the
ratchet teeth 576 overcoming the force of the return spring 584 and
moving the pawls 586 into engagement with the ratchet teeth 587.
When this is the case, the handle 511 can be progressively pressed
against the body 502 to cause the pawls 586 to progressively
advance in the ratchet teeth and click by successive ratchet teeth
to latch the handle 511 in the successive positions as it is
advanced and as the jaws 600 are being closed on the gall bladder.
If during this procedure it is desired to release the gall bladder
and take another grasp, this can be readily accomplished merely by
pressing on the lever 511 permitting the pawls 586 to disengage
from the teeth and to permit the grasper to open under the force of
the coil spring 526. Alternatively, the handle 511 can continue to
be compressed until the gall bladder has been firmly grasped during
which time the pawls 586 will progressively advance in the ratchet
teeth 587 and be retained therein.
As soon as the assistant has ascertained that the jaws 600 have
firmly grasped the gall bladder which can be ascertained by the
surgeon's feel of the resistance provided by movement of the handle
511, the ratchet mechanism can be placed in a locked position by
moving the ratchet knob 552 to the forwardmost or distal position
shown in FIG. 43A so that the tab 563 carried by the body 553
engages the lip 564 and urges the pawls 586 into engagement with
the ratchet teeth 587 to retain the same therein and to thereby
lock the grasper onto the gall bladder. The surgeon's assistant can
then release the handle 511 with the grasper having a firm grasp on
the gall bladder.
It should be appreciated that in connection with the use of the
hand-held surgical device 551, that the surgeon's assistant while
utilizing the grasper 599 can rotate the grasper 599 if that is
desired during the procedure. This can be readily accomplished
while utilizing the index finger of the hand holding the device 501
to rotate the nose cone 536 in the desired direction. As this is
being accomplished, audible sounds will be given out by the pin 594
engaging with the slots 593 carried by the actuator tube assembly
506. The pin 594 serves as a detent and retains the actuator tube
in the desired position.
From the foregoing it can be seen that in the embodiment of the
hand-held surgical device 501 hereinbefore described there has been
provided a device which is relatively lightweight, simple and
compact. It can be produced relatively inexpensively since a number
of features provided on the hand-held surgical devices hereinbefore
described have been eliminated and in particular the electrical
functions which have been eliminated. Even without these additional
features, the hand-held surgical device has many desirable
features. It is small and compact and can be readily used. It is
particularly adapted for use with tools such as graspers which may
require the use of a ratchet mechanism to aid in retaining the
grasper in engagement with the tissue being engaged by the
grasper.
Another hand-held surgical device 601 is shown in FIGS. 44-48 and
incorporates another embodiment of the hand-held surgical device of
the present invention. The device 601 is particularly adapted for
use in gynecological surgical procedures where it is desired that
the tools being utilized with the hand-held surgical device be
utilized in a vertical orientation. The hand-held surgical device
601 for that reason has been provided with a vertical hand grip.
The hand-held surgical device 601 consists of a housing 602 which
is configured to fit in the palm of a human hand. Thus the housing
602 is provided with an indentation 603 which is adapted to receive
the palm of the hand, the housing being formed so that the fingers
can extend around the housing and extend through and into a large
elongate hole 604 provided in a trigger handle 606. The handle is
provided with a recess 607 which is adapted to receive the index
finger of the hand. The housing 602 is provided with inclined
outwardly extending surfaces 608 on opposite sides of the housing
602 which are provided with spaced apart parallel raised
protrusions 609 which are adapted to be engaged by the thumb of the
hand to provide a counterforce to the finger action on the trigger
handle 606.
An actuator tube assembly 611 similar to that hereinbefore
described is mounted for reciprocatory movement in the housing 602
in a vertical direction and is provided with a bore 610. The
actuator tube assembly 611 includes a trombone-like connection
hereinbefore described for the previous embodiments. Means is
provided for causing reciprocatory movement of the actuator tube
assembly 611 and consists of a yoke 612 which is pivotally mounted
on a pin 613 carried by the housing 602 (see FIG. 45). The distal
extremity of the yoke 612 is pivotally connected by a pin 614 to
the trigger handle 606. The proximal extremities of the Y-shaped
yoke 612 is rounded as shown in FIG. 45 and is disposed between
first and second annular flanges 616 and 617 provided on the
actuator tube assembly 611. The trigger handle 606 is mounted for
movement in an elongate slot 618 provided in the housing 602 for
movement into and out of the housing. This is accomplished by
utilizing an idler arm 619 which has one end pivotally connected to
the trigger handle 606 by a pin 621 and which has the other end
secured to the housing 602 by a pin 623. The idler arm 619 is
disposed generally parallel to the yoke 613 to in effect provide a
parallelogram-type motion for the trigger handle 606. Spring means
in the form of U-shaped spring 621 is provided within the housing
602 for yieldably urging the trigger handle 606 into an outermost
position through the slot 618 as determined when the actuator tube
assembly 611 is in its proximal most or rearmost position within
the housing 602. One end of the U-shaped spring 621 engages a pin
622 in the housing 602 and the other end engages the pin 614
carried by the trigger handle 606.
Because of the vertical orientation of the hand-held surgical
device 601 it is necessary to provide means for rotating the
actuator tube assembly 611 which is accessible to the fingers of
the hand holding the hand-held surgical device 601. As shown
particularly in FIGS. 45 and 46, a right angle transfer rotation
mechanism is provided which takes the form of a thumb wheel 626
which is accessible through slots 627 provided on opposite sides of
the housing 602. Thumb wheel 626 is provided with recesses 628
spaced apart circumferentially of the thumb wheel 626 which is
adapted to be readily engaged by the thumb. The thumb wheel 626 is
also provided with axially disposed cylindrical protrusions 629 for
rotatably mounting the thumb wheel 626 in the structure of the
housing. As shown, the thumb wheel 626 is mounted so that it is
disposed in one side of the actuator tube assembly 611. Thumb wheel
626 is provided with additional cylindrical protrusions 631 which
are spaced apart circumferentially and extend at right angles to
the recesses 628. Protrusions 631 are adapted to mate with a gear
632 which is provided with longitudinally and axially extending
slots spaced circumferentially around the gear 632. The gear 632 is
affixed to the actuator tube assembly 611 and can be formed
integral therewith. Thus it can be seen that as the thumb wheel 626
is rotated by the thumb of the hand holding the device 601. The
rotary motion of the thumb wheel 626 is translated into rotary
motion of the gear 632 in a direction which is at right angles to
the rotation of the thumb wheel 626.
A ratchet mechanism 641 is provided in the housing which consists
of a U-shaped pawl member mounted within the housing. The U-shaped
pawl member 642 is provided with legs 643 and 644 which carry pawls
646 (see FIG. 45) which are adapted to engage teeth 647 by two
spaced-apart portions 606a and 606b of the trigger handle 606 (see
FIGS. 45 and 47). A U-shaped pawl 642 is provided with cylindrical
protrusions 651 which extend through the housing 602 and are
connected to knobs 652 provided on opposite sides of the housing
602. The knobs 652 are provided with outwardly projecting
protrusions 653 adapting the knobs to be engaged by the thumb of
the hand holding the device 601. The knobs 652 are operable to
swing the pawls 646 into engagement with the teeth 647. By swinging
movement of the knobs 652 which are movable in the direction
indicated by the arrow 654 (see FIG. 44) the knobs 652 are moved
into and out of recesses 656 formed in the outer surface of the
housing 602.
As described with the previous embodiment of the hand-held surgical
device shown in FIG. 31, the device is provided with cut and coag
push buttons 661 and 662 which are adapted to be engaged by the
index finger of the hand engaging the handle. It is also provided
with a rocker arm 666 mounted on the housing 602 which is adapted
to be engaged by the thumb of the hand for movement between the two
positions for operating two switches (not shown) for performing
suction and liquid delivery as hereinbefore described. These
switches 661, 662 and 666 are connected to electrical circuitry of
the type described in co-pending application Ser. No. 07/757,343,
filed Sep. 10, 1991, and are connected to a flex circuit which in
turn is mounted within the housing (not shown) and connected to a
cable 671. A nut 676 of the type hereinbefore described is mounted
on the actuator tube assembly 611. A bayonet-type recess 677 for
mating with surgical tools as hereinbefore described is provided on
the housing 602.
An outer tubular member 681 formed of a suitable material such as
plastic is secured to a nose cone 682. The nose cone 682 is secured
to the housing 602 in a suitable manner such as a threaded
connection (not shown). It carries a cylindrical tube 686 which is
slidably mounted over a metal tube 687 mounted on the distal
extremity of the actuator tube assembly 611 to provide a
trombone-like slide connection hereinbefore described.
Spring means is provided for yieldably disengaging and returning
the pawl 642 and for yieldably returning the knobs 652 into
positions so they are disposed within the recesses 656 provided in
the housing 602. The spring means consists of a coil spring 657
which is mounted on the pin 621 and has one end 658 engaging a
protrusion 642a and has the other end 659 engaging the housing
602.
Means is provided for giving an audible indication of the rotation
of the thumb wheel 626 and consists of a U-shaped spring member 634
(see FIG. 45 and 46). One end of the spring member 634 is provided
with a vee-shaped detent 636 which is adapted to engage vee-shaped
recesses spaced circumferentially apart on the thumb wheel 626
opposite the protrusions 631. The other end of the U-shaped spring
member 636 is suitably retained in the housing as for example by
mounting the same on rib portions 638 carried by the housing 602.
In this way it can be seen that as the thumb wheel 626 is advanced,
a click sound will be given by the advancement of the vee-shaped
detent 636 into and out of the recesses 637 as the recesses are
advanced past the detent 636 to thus give the surgeon utilizing the
device an audible indication of the amount of rotation and to
stabilize the rotary position.
From the foregoing it can be seen that there has been provided a
hand-held surgical device of various configurations which all
utilize a tool actuator tube assembly. Each configuration has
advantages as hereinbefore described.
* * * * *